Charles Aznavour sang: “I am a histrion..but genius was born with me … “. Sometimes it happens that the theme of”histrionic“It does not turn into music – using the term art in the musical song mentioned above seems excessive to me – and is included in the field of pathology.
What characterizes the histrionic personality disorder, fascinating in the term but intense source of discomfort for the subjects who suffer from it and for those who have to, in various capacities, interact with them?
Certainly in the subject histrion On an interpersonal level, an intense – often “deregulated” emotion emerges, a characteristic that in any case also belongs to many other personological problems – externalized with theatrical modalities (this element is the most characteristic of histrionic disorder and justifies the name) and constant attempts to obtain attention, approval and support from others. More or less explicit seductive conducts are used for this purpose and in any case inadequate to the context.
The histrion type It is found more frequently in the female sex but in reality it is also present among men in a not negligible percentage: a man and a woman with histrionic disorder They can respectively represent caricatures of masculinity (“machismo” and dongiovannism) and femininity (a “fatal femme”, super-emotional and extremely treated from an aesthetic point of view).
The central nucleus ofhistrionat the relational level, concerns the continuous search for being the center of attention and extreme discomfort when this does not happen: in order to achieve the purpose of being considered and arousing the interest of the other i histrionic subjects They are told by exaggerating episodes of life, inventing that stories that have happened, or in any case not very likely, presented as real and coloring everything with an extreme level of theatrical or seductive dramatization. Initially thehistrion It can arouse in the listener even curiosity and charm.
The nuclear element ofhistrionic It is focusing attention to activating the other’s interest in itself at the expense of the decoding of one’s internal experiences: it is considered according to others by experimenting with a sense of fragility of one’s identity. It is precisely this fragility that thehistrionic Try to mask with an emotional expressiveness at the same time dramatic and fatua, considering relationships as more intimate than they are (in reality the difficulty consists in achieving an authentic emotional intimacy within a relationship). THE
l depending on the other attention brings the subject histrion to be particularly sensitive to waste and separations not decided by him. It may happen that thehistrionic In order to avoid the interruption of a relationship, it can resort to extreme gestures aimed at attracting the attention of others, reaching self -injurious acts or demonstrative suicide attempts.
A further element that is found is the high suggestibility of these subjects: opinions and feelings can be easily influenced by beliefs and moods of others or by impressions and enthusiasm of the moment. To give an example, personal interests or the scheme of values may vary according to the values and interests of the partner of the moment.
THE’histrion It can show itself intolerant to frustrations and subject to frequent states of boredom: for this reason it is inclined to seek immediate gratifications to one’s needs or stimulations of particular emotional intensity. Often who has a histrionic disorder He is intensely worried about his physical appearance – precisely as a tool to attract attention – showing himself particularly troubled in case of criticism and willing to take care of it to take care of it, up to show symptoms of dysmorphophobia or eating disorders.
The reason for the histrionic disorder It is still not known, as happens for other personality disorders. The most likely hypothesis is that there is a concomitance of factors: from a biological point of view, a set of “innate” temperamental traits was observed at the base characterized by hypersensitivity and tendency to external research of gratifications.
From a psychosocial point of view, it is observed among the people who have developed a histrionic disorder Having experienced difficulties in the childhood in the satisfaction of the legitimate needs of attention and care. In some cases the subjects have been appreciated by the parental figures for their appearance and for their qualities of entertainers, rather than for their way of being, learning the idea, which will show themselves dysfunctional in time and source of great suffering, which, to satisfy their emotional needs and formulate requests, one must use the physical appearance and seductivity thus behaving like this histrion. In other situations we observe subjects who have received attention and care in childhood only when you sick, thus learning to seek care only through physical complaints. What follows?
The histrionicby continually implementing manipulative strategies, they come to compromise their sentimental, social and professional relationships by creating the conditions for the appearance of other psychopathological paintings. Theatrical modalities can induce others to consider them superficial and non -authentic and to activate wary or overcoming responses. The dramatic requests for help and excessive care, activated when you have the feeling of not being considered or having to face the difficulties of life without the desired support, can lead to the removal of people considered significant. Excessive seductivity can be perceived by people of the same sex as threatening for their couple relationship and activate competitiveness of competitiveness or distance in the relationship. In the workplace this conduct can be inadequate and activate feelings, aimed at histrionic subjectof little consideration and devaluation on the professional level.
As happens in personality disorders, also thehistrionic It is unlikely that he ask for help for his disorder, of which in the vast majority of cases he is not aware of it. Often a treatment for mood disorders or states of anxiety are requested following the considerable difficulties encountered in the life path. When these symptoms are particularly disabling, drug therapy can be used which, however, cannot be separated from a psychotherapy treatment.
Some treatment programs for personality disorders were created in the field of cognitive-behavioral therapy. The Beck and Freeman model focuses on the recognition and questioning of dysfunctional beliefs about itself, others and the world. These beliefs would be generated by distortions of reality (cognitive distortions) and would constitute cognitive patterns (basic cognitive structures that allow you to organize experience and behavior).
In the case of the therapy of histrionic disorderthe patient is helped to identify his emotions, the thoughts and events to which they are correlated, assuming a difficulty of the subject in implementing these operations. This work, together with the evaluation of the consequences of their actions, would help the patient to lower his dysfunctional impulsiveness. In a second moment the therapist collaborates with the patient in order to analyze and modify the dysfunctional central beliefs of the type: “I am unable to manage my life”, “you have value if you have loved everyone”, “losing a relationship is a drama to which there is no remedy”.
The belief of being unable to take care of itself would bring the histrion subject to constantly seek attention and care by others. Believe that the interruption of an emotional relationship can be disastrous would push the histrionic people Not to close unsatisfactory and inauthentic relationships by feeding the sense of inability to make it alone and the feeling of inauthenticity. We try to modify these beliefs by using different techniques including imaginative techniques, behavioral experiments, assertiveness or problem solving exercises that improve the sense of self-effectiveness in the patient.
The therapeutic process is implemented through a collaborative empiricism in which it is the patient himself who gradually identifies and learns to satisfy his needs in a more functional way, rather than waiting for others to do it or that an idealized therapist does it as a salvific and omnipotent.
In some histrionic subjects The integration of Beck and Freeman therapy has proved effective with a training for social skills aimed at modulating emotions and impulsive behaviors and improving empathic skills by training the focus of the histrion subject on the emotions and needs of the other.
Jeffrey Young’s The-Focused Therapy scheme is a treatment that integrates the cognitive-behavioral approach with approaches based on object relationships and gestalt. According to this approach, in the patient with histrionic personality disorder The dysfunctional schemes “emotional deprivation” (belief on the basis of other people will not provide the emotional support they need), “imperfection” (belief of being imperfect, inadequate, unpleasant and lower than the others) and “search for approval” (belief according to which one must always try to be accepted, sacrificing the real sense of self) would be active. The identification and modification of these schemes is the aim of therapy.
As always happens, reading the intervention protocols is different from dealing with the histrionic disordera term that appears “light” in the range of psychopathological nomenclature: in reality it is a difficult disorder to be treated precisely because the inauthenticity of the relationships leads the patient not to build a valid therapeutic alliance and the therapist to feel feelings of scarce endurance of the case.
I would conclude by saying to patients not to despair that they can receive a valid form of help, which requires time but it is possible, and to future therapists to invest in a valid professional training. To expert therapists I can only ask for advice on how to approach the histrion patient.
